tbuckley/cabot-search huggingface dataset:
Abstract 14020: Right Ventricular Strain Predicts Adverse Outcomes in Patients Undergoing Coronary Artery Bypass Grafting
Authors: Lisa S Duus, Flemming J Olsen, soeren Lindberg, Thomas Fritz-Hansen, Sune Pedersen, Allan Iversen, soeren galatius, Rasmus Mogelvang, Tor Biering-srensen
Journal: Circulation (2021)

Background: Evolvement in speckle-tracking echocardiography (STE) enable a detailed layer-specific analysis of the right ventricular (RV), which has shown to be a promising way of quantifying RV systolic function. We aimed to evaluate the usefulness layer-specific RV free wall strain (RVFWS) for predicting cardiovascular outcome in patients undergoing coronary artery bypass grafting (CABG). Methods: We studied 317 patients scheduled for CABG, with echocardiography prior to surgery. RV STE was performed to acquire endocardial, midmyocardial, and epicardial RVFWS. The endpoint was a composite of heart failure (HF) or cardiovascular death (CVD). Cox proportional hazards regression were used to assess the prognostic value. The multivariable adjustments included among other age, sex, hypertension and LVEF. Restricted cubic spline models were created to visualize the incidence rate for each RVFWS. Results: Of 317 patients, 30 (9.5%) reached the endpoint at a median follow-up of 3.5 years. The mean age was 67 years, 83% were men, and the mean LVEF was 50%. In univariable analyses all three layers were associated with a higher risk of the outcome (figure). All three layers remained independently associated with the outcome after multivariable adjustment (endo: HR 1.07 (1.01-1.13), mid: HR 1.06 (1.01-1.12), epi: HR 1.06 (1.01-1.11), per 1% absolute decrease). Reduced endo-RVFWS and mid-RVFWS posed a two-fold increased risk of developing HF and/or CV death as compared to those with preserved RVFWS (incidence rate of 3.7 (2.39-5.63) vs. 1.5 (0.76-2.82), events per 100 patient-years for reduced and preserved endo-RVFWS as well as reduced and preserved mid-RVFWS). Patients with reduced epi-RVFWS did not exhibit a higher risk of the outcome as compared to those with preserved epi-RVFWS. Conclusion: In patients undergoing CABG, RVFWS is a predictor of cardiovascular outcomes, and particularly reduced endocardial and midmyocardial RVFWS pose an increased risk of outcome.
Abstract 12916: Improving Cardiovascular Health in Black Men Through a 24-week Community-Based Lifestyle Change Intervention: The Black Impact Program
Authors: Joshua J Joseph, Timiya Nolan, Amaris Williams, Alicia McKoy, Songzhu Zhao, Emmanuela Aboagye-Mensah, Bjorn Kluwe, James Odei, Guy Brock, Dana Lavender, John Gregory, Darrell Gray
Journal: Circulation (2021)

Introduction: Higher cardiovascular health scores, using American Heart Association’s (AHA) Life’s Simple 7 (LS7), have been associated with lower risk of cardiovascular disease, type 2 diabetes, cancer and mortality among all racial/ethnic groups. Nationally, Black men have the lowest levels of LS7. Thus, a study was conducted to evaluate the impact of a community-based lifestyle change program on LS7 among Black men. Hypothesis: A community-based lifestyle change program will increase levels of LS7 among Black men. Methods: Black adult males (n=74) from a large Midwestern city participated in Black Impact, a 24-week community-based lifestyle change program adapted from the Diabetes Prevention Program and AHA’s Check, Change, Control Blood Pressure Self-Management Program which incorporates AHA’s LS7 framework. The change in a LS7 score (range 0-14) from baseline to 12 and 24 weeks was evaluated using a linear mixed effects model adjusted for age, education and income. Results: The mean age of participants was 52 ±10 years. The men were sociodemographically diverse with annual income ranging from &lt;$20,000 (7%) to ≥$75,000 (25%). Twenty-five percent were college graduates, 73% had private insurance and 84% were employed. In fully adjusted models, LS7 score at baseline was 7.12 and increased 0.67 (95%CI: 0.14, 1.20, p=0.013) and 0.93 (95%CI: 0.40, 1.46, p=&lt;0.001) points at 12 and 24 weeks, respectively, compared to baseline. Sensitivity analysis evaluating 5 components (excluding diet and physical activity) and 6 components (excluding diet) also showed significant increases at 12 and 24 weeks (all p&lt;0.01). Conclusions: The Black Impact lifestyle change single-arm pilot program showed that a community-based lifestyle intervention has the potential to improve LS7 in Black men. Further randomized studies are urgently needed to improve cardiovascular health and advance cardiovascular health equity in Black men.
Abstract 12177: Analysis of the Primery Factor Which Predicts the Incidence of Esophageal Injury After Catheter Ablation of Atrial Fibrillation
Authors: Miwa Ito, Hisanori Kanazawa, Yusei Kawahara, Tadashi Hoshiyama, Syozo Kaneko, Kenichi Tsujita
Journal: Circulation (2021)

Background: Esophageal injury (EI) is a serious complication after radiofrequency catheter ablation (CA) of atrial fibrillation (AF).Although life-threatening complications are rare, CA of posterior wall of left atrium (LA) may result in EI ranging from mild erythema to ulceration. However, predictable factor of EI is unclear. A recent study appreciably suggested that postprocedural upper gastrointestinal tract endoscopy could identify EI, and higher intraesophageal temperature measured by a luminal esophageal temperature monitoring (ETM) was associated with the occurrence of EI. Until now, there is no widely accepted approach to minimize EI caused by CA for AF. Objective: We sought to identify risk factors of EI caused by CA for AF, and explore the potential management of EI in this study. Methods: Among 568 patients who underwent CA of AF, endoscopy was performed the next day after CA to examine for EI. The incidence of EI was compared between 260 patients who done ETM (ETM group) and 308 patients who didn’t done ETM (Non-ETM group) during CA. The Shortest Distance between esophagus and posterior left atrium measured on contrast Computed Tomography (SD-CT) was also compared between both groups. Results: No differences were observed between both groups in total number and amount of applications. However, EI occurred more frequently in Non-ETM group (9/260 patients; 3.4 % vs 27/308 patients; 8.8 %, p=0.042). There was no significant difference in SD-CT between ETM and Non-ETM group. However, SD-CT in patients with EI was significantly shorter than SD-CT in patients without EI, both in ETM (2.3±0.6 vs 4.1±0.8mm, p&lt;0.001) and in Non-ETM group (2.3±0.3 vs 4.1±1.3 mm, p&lt;0.001), respectively. The rising speed of temperature was faster in patients with EI than those without EI (7.6±5.6 vs 10.7±6.2 sec, p=0.025). Maximum arrival temperature of esophagus was higher in patients with EI than those without EI (42.4±5.7 vs 41.2±1.5, p=0.038).Receiver operating characteristic curves were constructed to assess the ability of SD-CT and esophageal temperature to predict EI. Conclusions: The use of ETM is safe and necessary in order to prevent the occurrence of EI. The incidence of EI was correlated with SD-CT. ETM reduced EI, especially in patients with short SD-CT.
Abstract 14059: Lycopene Reduces Formation of Cholesterol Crystals and Accelerates Their Dissolution
Authors: Ivan M Petyaev
Journal: Circulation (2021)

Introduction: Cholesterol crystals are one of the main culprits behind the rupture of atherosclerotic plaque and resultant thrombosis, the process responsible for the development of heart attack and ischemic stroke, the world’s leading causes of mortality. Today there are no drugs or treatment able to target these crystals. Hypothesis/Objectives and Methods: Effect of lycopene on the growth of cholesterol crystals was investigated. A study was also made on the effect of this carotenoid on the dissolution of already formed cholesterol crystals in vitro and in human atherosclerotic plaques. Results: It was found that lycopene was directly able to disrupt, slow down and facilitate the reversal of the cholesterol crystallisation process. In in vitro experiments, lycopene delayed the time of the beginning of the process by 8 fold and its rate of this process itself by 5 fold. In addition it was able to reduce the cholesterol mass involved into crystallisation by 60%, fig. 1. Even when the cholesterol crystals were formed in the presence of lycopene their size was significantly smaller than when the crystals grew undisrupted, fig. 2. This effect could be observed in a ratio of 1 molecule of lycopene to 1,000-10,000 molecules of cholesterol, which indicates that these two molecules can create a thermodynamically favourable complex, which triggers a long-range ordering transition in their folding. Conclusion: The presented findings provide a sound rationale for future studies of lycopene on its potential prevention of cholesterol crystal formation and facilitation of their disassembly in patients with clinical complications of atherosclerosis.
Abstract 13310: Early Percutaneous Coronary Intervention: Risks and Outcomes in Patients With Cancer
Authors: Marialuisa Scarpone, Maria Bergami, Edina Cenko, Zorana Vasiljevic, Marija Zdravkovic, Marija vavlukis, Sasko Kedev, Davor Milicic, Olivia Manfrini, Raffaele Bugiardini
Journal: Circulation (2021)

Background: Patients with malignancies may have a high pro-thrombotic status as well as a high risk of hemorrhagic events either due to the tumor or its treatment.For this reason, these patients have always been excluded from randomized clinical trial on percutaneous coronary intervention (PCI). Aim: To investigate the safety of PCI in patients with malignancies admitted for an AMI. Methods and Results: Retrospective analysis on an international European ACS registry. Primary endpoint: 30-day mortality. Secondary endpoint: periprocedural-complications. There were 273 patients (35% women) with AMI and malignancies. Colon (19%), prostate (14%), breast (13%), lung (8%) and blood (8%) malignancies were the most frequents type of cancer. Women and men had similar age (68 ±11.5 vs 69.1 ±11.5, p=ns). STEMI was in 56% of patients (with no significant gender difference: 51% men vs 65% women, p=0.09). PCI was performed in 64% of patients (with primary PCI in 75% of STEMI). The rate of complications during cardiac catheterization and intervention was 6.5% (2.1% distal embolization, 2.1% no-reflow, 0.7% acute closure, 0.7% dissection, 0.7% perforation, none major bleeding). Nobody among patients that had cardiac catheterization and intervention complications died during hospital stay. In-hospital mortality was 5.9%. The group of patients treated with PCI had a significantly lower rate of death then that of those treated non invasively (1.7% vs 13.1%, p&lt;0.00001). Factors associated with lower probability to receive cardiac catheterization were older age (OR 0.94, 95% CI 0.92-0.97) and absence of typical chest pain at admission (OR: 0.38; 95%CI:0.18-0.81), but the type of malignancy and gender were not. On multivariable model, age (OR 1.1, 95%CI 1.03-1.17) and PCI (OR 0.16 95%CI, 0.04-0.59) were independently associated with the risk of death for ACS (increased and decreased risk, respectively). Conclusion: These preliminary data from real word support the safety use of PCI in patients with malignancies and ACS, which have always been excluded from randomized clinical trial.
Abstract 13378: Preclinical Assessment of the Feasibility of Thoracic Vein Isolation With Sub-Second Pulsed Field Ablation Using a Focal Lattice-Tip Catheter
Authors: Iwanari Kawamura, jacob s Koruth, Mohit Turagam, Daniel Musikantow, Edward Chu, Marc Miller, William Whang, Srinivas Dukkipati, Vivek Y Reddy
Journal: Circulation (2021)

Introduction: Focal pulsed field ablation (PFA) using a 9mm lattice-tip ablation and mapping catheter (Sphere-9, Affera, Inc) can be used to deliver focal pulsed field ablation (PFA) at various atrial sites. We have previously shown that lattice-tip PFA using 3-5 sec deliveries creates efficacious atrial lesions. However, lattice-tip PFA still has a potential of shortening the ablation duration using tailored pulse designs. Accordingly, we assessed the feasibility and safety of thoracic vein (TV) isolation using ≤ 1 sec duration focal PFA in swine. Methods: A total of 4 swine underwent transfemoral venous access under general anesthesia. PF deliveries ≤ 1s were used to ablate a total of 8 TVs (4 pulmonary veins [PVs], 4 superior vena cava [SVC]) using lattice-tip catheter and its compatible PF generators (HexaPulse, Affera, Inc). TV potentials, venograms and phenic nerve injuries were assessed both acutely and after 24 hours; then, the animals were humanely sacrificed. Results: All 8 of 8 targeted veins (100%) were acutely isolated. Mean PFA application time for PVs and SVC was 13.1±4.1 and 12.8±1.0 sec, using 15.5±1.7 and 16.0±4.2 PFA applications, respectively. Persistent isolation was achieved in 7 of 8 (87.5%) TVs at 24 hrs. Gross necropsy demonstrated continuous and transmural lesions along the isolation line. The one SVC with reconnection demonstrated an obvious visual gap in the line. Microbubbles on the intracardiac echography were not seen during PFA applications, venography showed no reduction in vessel diameter, and the phrenic nerves were preserved in all swine. Conclusion: Significant shortening of pulse duration was not associated with compromise of acute lesion characteristics and TV isolation in a porcine model. But because of the potential discordance between preclinical and clinical outcomes, this strategy should be carefully tested in clinical studies.
Abstract 13638: Protein Calorie Malnutrition is an Adverse Prognostic Marker in Atrial Fibrillation Patients: An Analysis of the National Inpatient Sample Registry
Authors: Ramtej Atluri, Mouna Kodali, Sujitha Velagapudi, Mukunthan Murthi, Genaro Velazquez
Journal: Circulation (2021)

Introduction: Protein Calorie Malnutrition (PCM) is not thought to be associated with atrial fibrillation (AF). Some research has stipulated that overweight AF patients may have a better prognosis than those with normal weight, however, the interaction between poor nutritional status and AF has not been well explored. Dyselectrolytemias secondary to malnutrition could confer a poor prognosis in AF patients. We aimed to assess the impact of PCM on outcomes in patients admitted with AF. Methods: A retrospective cohort study was conducted using the Nationwide Inpatient Sample from 2017. About 412,159 hospitalizations who had AF as their primary diagnosis were identified and stratified based on the presence of PCM using ICD-10 codes. Multivariate regression analysis was used to adjust for confounders and to analyze the variables. The selection of covariates was done with a univariate screen and literature review. Results: Out of the 412,159 hospitalized patients with AF, 11,590 individuals had PCM. In-hospital mortality in AF patients with PCM were significantly higher than those without (4.62% vs 0.77%); p&lt;0.0001. When adjusted for patient demographics, comorbidities, and hospital characteristics, AF patients with PCM had a higher risk of mortality (aOR=3.45, p&lt;0.0001), cardiac arrest (aOR=2.41, p&lt;0.0001), PE (aOR=2.06, p&lt;0.0001), sepsis (aOR=4.72, p&lt;0.0001), pneumonia (aOR=2.25, p&lt;0.0001), AKI (aOR=1.41, p&lt;0.0001), acute respiratory failure (ARF) (aOR=1.81, p=0.011), and being intubated (aOR=1.45, p=0.019). When adjusted similarly, AF patients with PCM had longer length of stay (LOS) by 2.76 days (mean LOS: 6.61 vs 3.25 days) (p&lt;0.0001) and an additional hospital cost (HC) of $18,373 (mean HC: $62,093 vs $39,934) (p&lt;0.0001). However, there was no difference in the risk of developing stroke (aOR=1.23, p=0.26) in AF patients with PCM. Conclusions: AF patients with PCM had worse outcomes in terms of in-hospital mortality, LOS, HC, cardiac arrest, PE, sepsis, pneumonia, AKI, ARF, and being intubated compared to those without PCM. This suggests that PCM is an adverse prognostic marker in this population. Current limitations include the underrepresentation of metabolic derangements due to inadequate coding within this administrative database.
Abstract 12240: Sarcomere Mutation Was Not Related To The Prognosis Of Obstructive Hypertrophic Cardiomyopathy Patients With Atrial Fibrillation
Authors: Jian Zhang, Changsheng Zhu, Changrong Nie, Kunlun Yin, Changpeng Song, Yang Zhang, Manyun Huang, Xinxin Zheng, Jie Lu, Zhou Zhou, WANG Shuiyun, Xiaohong Huang
Journal: Circulation (2021)

Introduction: Hypertrophic cardiomyopathy (HCM) is the most prevalent inherited heart disease. The presence of a sarcomere mutation is a powerful predictor of adverse outcomes. Two-thirds of the patients are obstructive HCM (OHCM). Atrial fibrillation (AF), a common complication, is associated with poor long-term prognosis in OHCM patients. However, the effect of sarcomere mutation on the clinical phenotype or prognosis in OHCM patients with AF is unknown. Methods and Results: We retrospectively collected 41 OHCM patients with AF who underwent septal myectomy in Fuwai hospital which were separated into 2 groups, sarcomere mutation (+) group and sarcomere mutation (-) group (n=25 and 16). Statistical analysis was performed by Mann-Whitney U test, Chi-square test, Kaplan-Meier survival analysis, and log-rank test with SPSS 23.0 and GraphPad 8.0. Patients in sarcomere mutation (+) group were younger (42.0±14.5 vs. 57.6±11.7 years, p=0.001). There was no significant difference between sarcomere mutation (+) and sarcomere mutation (-) group on other baseline variables and prognosis (log-rank p=0.077). Conclusions: In conclusion, we did not find that the presence of a sarcomere mutation worsen the prognosis in OHCM patients with AF. Multi-center prospective studies with large samples are needed to further confirm our results.
Abstract 12006: Smooth Muscle Cell Embryologic Origin Does Not Define Propensity for Phenotype Modulation in Murine Marfan Syndrome Aortic Root Aneurysm
Authors: Albert J Pedroza, Alex R Dalal, Rohan Shad, Nobu Yokoyama, Ken Nakamura, Michael P Fischbein
Journal: Circulation (2021)

Introduction: Vascular smooth muscle cells (SMC) undergo phenotype modulation (silenced contractile genes and activated proteolytic/synthetic genes) in Marfan syndrome (MFS) aortic aneurysm. Aortic root SMCs develop from the second heart field (SHF) proximally and neural crest (NC) distally. We hypothesize that both developmental lineage and hemodynamic factors dictate SMC vulnerability to phenotype change, promoting focal aortic root aneurysm. Methods/Results: Aortic roots from adult MFS and littermate control mice (n=4 each sex) with a knockin fluorescent SHF tracing construct ( Nkx2-5 cre ) were sorted for lineage-resolved single cell RNA sequencing (scRNAseq). Modulated SMCs (modSMC) were enriched in MFS vs. controls (18.1% of all SMCs vs. 2.2%) and originated from both SHF (15.5%) and NC (20.2%) lineages, ruling out complete lineage specificity. NC-derived modSMCs expressed more aggrecan ( Acan ) and sclerostin ( Sost ) while small proteoglycans decorin ( Dcn ) and lumican ( Lum ) were enriched in SHF modSMCs. Insulin-like growth factor binding protein-2 ( Igfbp2 ) was a lineage-independent modSMC marker. RNA in situ hybridization localized Igfbp2 + SMCs within SHF/NC overlap in the aortic root. To study regional SMC propensity for modulation due to hemodynamic stresses, we generated aortic pressure overload via 27-gauge transverse aortic arch constriction (TAC) or sham surgery on healthy Myh11 cre / Rosa tdT (SMC-traced) mice. TAC induced mild root dilation vs . sham (1.93±0.07 mm vs. 1.69±0.09 mm, n=4, p&lt;0.01). scRNAseq showed SMC phenotype modulation comparable to MFS in TAC mice and spatially concentrated in the aortic root. Conclusions: Embryologic origin does not dictate aortic SMC propensity for pathologic phenotype change in MFS but does promote distinct ECM proteoglycan gene activation. Aortic pressure overload incites root SMC modulation, suggesting hemodynamic effects may promote regional susceptibility to SMC-mediated aortic remodeling.
Abstract 13639: The Impact of Income Level on All-Cause and Cardiovascular Mortality Across the Spectrum of Cardiovascular Health &amp; Disease Among Adults in the United States
Authors: Madiha Khan, Isaac Acquah, Zulqarnain Javed, Mohamad Taha, Najah Khan, Miguel Cainzos-Achirica, Kobina Hagan, Safi U Khan, Michael D Shapiro, Michael J Blaha, Ron Blankstein, Salim S Virani, Garima Sharma, Javier Elizondo, Khurram Nasir
Journal: Circulation (2021)

Introduction: There is increasing interest in the role of income level as a social determinant of health for cardiovascular disease (CVD). In this study we examine the interplay of household income, all-cause mortality, and CVD mortality in a representative US adult population. Methods: We used National Health Interview Survey data from 2006-2014 including adults ≥18 years. Mortality data with follow-up till December 2015 was derived from the National Death Index. We evaluated age-adjusted all-cause, CVD and non-CVD mortality rates across income levels (lowest, low, middle, and high; defined based on based on the percentage of family income relative to the federal poverty level), among people with and without ASCVD at baseline. We further classified participants without ASCVD as having optimal (0-1 risk factors), average (2-3), and poor (&gt;3) cardiovascular risk factor (CRF) profile. Cox regression models were used to evaluate the association between income and mortality. Results: The analysis included 256,991 adults, representing ~230 million adults annually. Mean age was 46.3 (SD=17.7), 52% were women, 13% NHB, and 8% had ASCVD. Overall, 18% were in the lowest income category compared to 39% in highest group. During the 10 years of follow up, participants with highest income and optimal CVH had the lowest all-cause and cause-specific mortality rates, whereas those with lowest income and poor CVH had the highest rates (Figure). Additionally, multivariate adjustment for demographics and CRF, lower income was associated with increased all-cause mortality (lowest/low vs middle/high income, HR: 1.22; 95% CI: 1.11-1.35 CVD vs non-CVD HR: 1.24, 95% CI: 1.16-1.33) and CVD mortality (lowest/low vs middle/high income: HR: 1.29, 95% CI: 1.07-1.56 CVD vs non-CVD HR: 1.44, 95% CI: 1.23-1.67). Conclusions: In a US representative population, lower income adults were consistently associated with increased risk of all-cause and CVD mortality irrespective of baseline CVD status.